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Understanding massive stroke

A stroke is what happens when blood flow to part of the brain is interrupted. The result is oxygen deprivation to brain tissue. This can have devastating consequences. The ability to recover from a stroke depends on the severity of the stroke and how quickly you get medical attention.

A massive stroke can be fatal, as it affects large portions of the brain. But for many people experiencing a stroke, recovery is long, but possible.

The severity of symptoms depends on the location of the stroke and the size of the stroke. The symptoms of a stroke can include:

In severe cases, rigidity and coma can occur.

Strokes occur when blood flow to your brain is interrupted. They can be ischemic or hemorrhagic.

Ischemic stroke

The majority of strokes are ischemic. An ischemic stroke results from a clot that blocks blood flow to a particular region of the brain.

The clot may be a cerebral venous thrombosis (CVT). This means it forms at the site of the blockage in the brain. Alternatively, the clot may be a cerebral embolism. This means it forms elsewhere in the body and moves into the brain, leading to a stroke.

Hemorrhagic stroke

A hemorrhagic stroke occurs when blood vessels in the brain rupture, causing blood to accumulate in the surrounding brain tissue. This causes pressure on the brain. It can leave part of your brain deprived of blood and oxygen. Around 13 percent of strokes are hemorrhagic, estimates the American Stroke Association.

According to the Centers for Disease Control and Prevention, new or persistent strokes affect 795,000 Americans each year. The risk factors for a stroke include a family history of stroke, as well as:


In most age groups — with the exception of older adults — strokes are more common in men than women. However, stroke is deadlier in women than in men. This may be because strokes are most common in older adults, and women usually live longer than men. Birth control pills and pregnancy can also increase a woman’s risk of stroke.

Race or ethnicity

People in the following groups have a higher risk of stroke than Caucasians. However, risk disparities among people in these groups decreases with age:

  • Native Americans
  • Alaska Natives
  • African-Americans
  • people of Hispanic descent

Lifestyle factors

The following lifestyle factors all increase your risk of stroke:

Medications and medical conditions

Birth control pills can increase your risk of an ischemic stroke. Medications that thin the blood can increase your risk of hemorrhagic stroke. These include:

Sometimes blood thinners are prescribed to decrease the risk of ischemic stroke if your doctor feels you’re at high risk. However, this can also increase your risk of a hemorrhagic stroke.

Pregnancy and certain medical conditions can also increase your risk of stroke. These conditions include:


Adults over age 65 are at the greatest risk of stroke, especially if they:

  • have high blood pressure
  • have diabetes
  • are sedentary
  • are overweight
  • smoke

If your doctor suspects you’re having a stroke, they’ll perform tests to help them make a diagnosis. They can also use certain tests to determine the type of stroke.

First, your doctor will perform a physical exam. They’ll test your mental alertness, coordination, and balance. They’ll look for:

  • numbness or weakness in your face, arms, and legs
  • signs of confusion
  • difficulty speaking
  • difficulty seeing normally

If you’ve had a stroke, your doctor may also perform tests to confirm the type of stroke you’ve had and to make sure they’re giving you the right kind of treatment. Some common tests include:

If you’re having a stroke, you need emergency care as soon as possible. The sooner you get treatment, the better your odds are of survival and recovery.

Ischemic stroke

Guidelines regarding treatment of stroke were updated by the American Heart Association (AHA) and American Stroke Association (ASA) in 2018.

If you arrive in the emergency room for treatment 4 1/2 hours after symptoms begin, emergency care for an ischemic stroke can involve dissolving the clot. The clot-busting drugs known as thrombolytics are often used for this purpose. Doctors often give aspirin in emergency settings to prevent any additional blood clots from forming as well.

Before you can get this kind of treatment, your healthcare team must confirm that the stroke isn’t hemorrhagic. Blood thinners can make a hemorrhagic stroke worse. This can even lead to death.

Additional treatments can include a procedure to pull out the clot from the affected artery using small catheters. This procedure can be performed 24 hours after symptoms begin. It’s known as a mechanical clot removal or mechanical thrombectomy.

When the stroke is massive and involves a large part of the brain, surgery to relieve pressure buildup in the brain may also be necessary.

Hemorrhagic stroke

If you’re having a hemorrhagic stroke, emergency caregivers may give you medications to lower your blood pressure and slow the bleeding. If you’ve been using blood thinners, they may give you drugs to counteract them. These medications worsen bleeding.

If you have a hemorrhagic stroke, you may need emergency surgery depending on the severity of the bleeding. They’ll do this to repair the broken blood vessel and to remove excess blood that may be putting pressure on the brain.

Complications and resulting impairments become more serious depending on the severity of the stroke. Complications can include the following:

Rehabilitation services can help minimize complications and may include working with:

  • a physical therapist to restore movement
  • an occupational therapist to learn how to perform daily tasks, such as activities involving personal hygiene, cooking, and cleaning
  • a speech therapist to improve speaking ability
  • a psychologist to help cope with feelings of anxiety or depression

Some people who have a stroke recover quickly and can regain normal function of their body after just a few days. For other people, recovery may take six months or longer.

No matter how long it takes you to recover from your stroke, recovery is a process. Remaining optimistic can help you cope. Celebrate any and all progress you make. Talking to a therapist can help you work through your recovery, too.

Support for caregivers

During the recovery process after a stroke, a person may need ongoing rehabilitation. Depending on the stroke’s severity, this may be for a few weeks, months, or even years.

It can be helpful for caregivers to educate themselves about strokes and the rehabilitation process. Caregivers may also benefit from joining support groups where they can meet others who are helping their own loved ones recover after a stroke.

Some good resources to find help include:

  • National Stroke Association
  • American Stroke Association
  • Stroke Network

Your outlook depends on the severity of the stroke and how quickly you get medical care for it. Because massive strokes tend to affect large amounts of brain tissue, the overall outlook is less favorable.

Overall, the outlook is better for people who have an ischemic stroke. Because of the pressure they put on the brain, hemorrhagic strokes lead to more complications.

Follow these tips to prevent a stroke:

Your doctor may recommend or prescribe certain medications to help reduce your risk of stroke. These may include:

  • antiplatelet medication, such as clopidogrel (Plavix) to help prevent blood clots from forming in your arteries or heart
  • anticoagulants, such as warfarin (Coumadin)
  • aspirin

If you’ve never had a stroke before, you should only use aspirin for prevention if you have a low risk of bleeding and a high risk of atherosclerotic cardiovascular disease (e.g., stroke and heart attack).

Shop for aspirin online.